1982667374 NPI number — JOHN CHARLES QUINN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982667374 NPI number — JOHN CHARLES QUINN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

QUINN

Provider First Name:

JOHN

Provider Middle Name:

CHARLES

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1982667374

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/03/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

190 CAMPUS BLVD

Provider Second Line Business Mailing Address:

STE 200

Provider Business Mailing Address City Name:

WINCHESTER

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22601-2872

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

540-662-6135

Provider Business Mailing Address Fax Number:

540-662-5845

Provider First Line Business Practice Location Address:

190 CAMPUS BLVD

Provider Second Line Business Practice Location Address:

STE 200

Provider Business Practice Location Address City Name:

WINCHESTER

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22601-2872

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

540-662-6135

Provider Business Practice Location Address Fax Number:

540-662-5845

Provider Enumeration Date:

04/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  0101024719 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 08247800000 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 286071600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 0087193000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 550941600 . This is a "MD MEDICAID GRP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: C00085 . This is a "VA MEDICARE B - GROUP #" identifier . This identifiers is of the category "OTHER".
• Identifier: 3810003817 . This is a "WV MEDICAID GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 44156 . This is a "SENTARA PROFESSIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 001717437 . This is a "WV BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 006084176 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 015053 . This is a "ANTHEM PROFESSIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 2119648 . This is a "MAMSI PROFESSIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 000875693 . This is a "WV BLUE SHIELD - GROUP #" identifier . This identifiers is of the category "OTHER".